Zumba® Fitness (Ages 18+)

Fall 2019 Registration Form

First and Last Name

Phone Number

Email Address

Known Allergies or Medical Conditions

Attendance

Full Session (2 days/week; $70)Half Session (1 day/week; $35)

Acknowledgement of Risk:
As a participant in a Southington Recreation
Department adult exercise program, I acknowledge the fact that a risk of injury
may exist due to the nature of the program. I agree to hold harmless the Town of
Southington, the Recreation Department, its instructors and all persons
connected with the program in the event of any injury I might
incur. I am also aware that there are no
medical personnel in attendance and, as such, I choose to participate at my own
risk.